As a consultant working in a tertiary service I see the results of New Ways
of Working rather than participating directly myself. What emerges is a loss
of diagnosis, let alone any attempt at a differential.

New Ways of Working assumes that it is easy to tell, at the moment of
referral, whether or not a problem is complex or straightforward. In reality,
overt psychosis can be relatively straightforward to spot but such individuals
go to a psychiatrist. Left undiagnosed are complex personality disorder
(borderline pathology reduced to ‘depression’) and subtle or
unusual psychotic states such as encapsulated delusions or thought disorder,
described as ‘normal’.

I have been involved in an increasing number of cases where there have been
serious consequences of misdiagnosis, of the type that used to shame a part 1
candidate for MRCPsych. Diagnosis is still considered a fundamental part of
medicine, so why have we, apparently willingly, opted out of this aspect of
our medical discipline? I concur with those who worry about the demise of
psychiatry - what is the point of a discipline that seemingly anyone can
practice? The loss of differentiation between the disciplines does not
contribute to egalitarian practice, it only leads to non-specific and perhaps
unhelpfully focused treatment.